Alcohol addiction – wrong tracks and ways out

Alcohol gets into our brain via the bloodstream. What effects does this have on our body? Alcohol initially has a pleasantly intoxicating and relaxing effect, and lowers our inhibitions. Our heart rate increases, as does our blood pressure. Our blood vessels dilate and we feel more thirsty. As we consume more and more alcohol, the initially positive effects start turning negative. Our ability to think deteriorates, we cannot see as clearly, and our reactions and motor skills also diminish.

Possible further consequences after alcohol consumption: nervousness, aggression, depressed mood, palpitations, sweating and difficulty sleeping. Diarrhoea is another possible side effect as well as skin rashes.  

As the blood alcohol level continues to rise, we feel increasingly confused, lose our sense of orientation or suffer from nausea and vomiting. If the blood alcohol concentration is very high and if consumption becomes chronic and high-risk, there is a danger of fatty liver disease or even cirrhosis of the liver, dementia and – with binge drinking – alcohol poisoning.

Alcohol can enter the bloodstream at different speeds. It gets absorbed more quickly, for example, through:

• hot drinks (e.g. mulled wine)
• carbonated drinks (e.g. prosecco)
• drinks containing alcohol and sugar
• fast drinking
• an empty stomach

The effects of alcohol on people vary. It depends on different factors such as age, gender, body weight, illnesses or medication.

If we drink while we are eating food or over a longer time period, the level of alcohol in our bloodstream rises more slowly. Why? The body has time to break down some of the alcohol. This is why we should never drink quickly and never on an empty stomach.

But how exactly does the body break down alcohol? Ten per cent of the alcohol is excreted through the lungs, kidneys and skin. Most of it, however, is broken down by the liver. It does this in two stages, using enzymes. Certain metabolites that are formed in these two stages are highly toxic. Among other things, they attack the cell membranes. Excessive alcohol consumption activates the microsomal ethanol oxidising system (MEOS). Studies suggest that this is responsible for the habituation (development of tolerance) to alcohol.

The MEOS helps anyone who regularly consumes a lot of alcohol to break the alcohol down faster. The person concerned therefore needs more alcohol to produce an intoxicating effect. But this presumed “habituation” in no way means that alcohol becomes less toxic for the body. This fact makes it particularly dangerous: if we think we are slowly accustoming ourselves to alcohol, we are already moving in the direction of alcoholism.

At what point does drinking become alcoholism? The lines separating “normal”, misuse and harmful alcohol consumption from alcohol addiction are fuzzy. The limit for low-risk alcohol consumption is two standard drinks per day for men and one standard drink per day for women – with at least two alcohol-free days per week. This helps to avoid developing tolerance. One standard drink equates to one glass of schnapps, 100 ml of wine or 300 ml of beer.

The term alcohol abuse also applies when someone drinks to the point of intoxication or resorts to drinking alcohol in inappropriate situations, such as at work, while driving (0.05% BAC limit applies here) or during pregnancy.

The signs of alcoholism include the following diagnosis criteria:

1. Compulsive urge to consume alcohol (craving)
2. Reduced ability to control consumption
3. Withdrawal symptoms
4. Tolerance development (where increasing amounts of a certain substance are needed to achieve the desired effect)
5. Abandonment of other interests
6. Continuation of consumption despite knowing the harmful consequences

The effects of excessive alcohol consumption can be fatal for individuals as well as for society. Alcoholism not only has harmful consequences for the body, but also for the mind. Chronic alcohol consumption has been shown to fuel depression, sleep disorders, anxiety disorders and panic attacks. Physically, it often leads to loss of appetite and subsequent malnutrition.

Drinking heavily during pregnancy can damage the foetus. Besides mental and physical illnesses, alcoholism always causes or intensifies social problems. A frequent consequence of alcoholism is that people lose their job, family and friends. People who are alcohol dependent only think about their next drink. They increasingly isolate themselves, lose their interests and their enjoyment of life.

A professional must establish whether someone is actually addicted to alcohol. Alcohol-dependent people who decide to abstain should only go through the withdrawal process under medical supervision. This is because withdrawal symptoms can sometimes lead to severe physical and mental health problems, in the worst case to death. Medically controlled alcohol withdrawal can prevent such consequences.

Depending on the severity of the alcohol use disorder, withdrawal takes place as an inpatient in a hospital or clinic – or as an outpatient with a GP or psychiatrist. A combination of inpatient and outpatient treatment is also possible.

Alcohol withdrawal duration

The duration of the alcohol withdrawal process depends on how severe the alcohol use disorder is and how the treatment proceeds.

• Withdrawal: between 7 days and 3 weeks
• Withdrawal treatment: 3 to 6 months
  

Stages of alcohol withdrawal

1. Abstinence (physical dependency): radical renunciation of alcohol. The detoxification phase is conducted under medical supervision and monitoring. Severe withdrawal symptoms are alleviated by means of medication.
2. Withdrawal phase (psychological dependence): psychotherapeutic support after alcohol withdrawal and development of strategies for day-to-day life.
3. Aftercare and rehabilitation phase: support for returning to day-to-day life and for the period afterwards. Guidance by professionals and self-help groups to prevent relapses.

Alcohol withdrawal symptoms

• Anxiety episoes
• Nervousness
• Headaches
• Shaking
• Sweating
• Blood pressure irregularities
• Seizures
• Hallucinations
• Delirium

Various treatments such as outpatient medical, psychotherapeutic and medicinal services for withdrawal and therapy are reimbursed by the health insurance company under basic insurance, after deduction of the excess and deductible. Depending on individual circumstances, this can be provided on an outpatient or inpatient basis. Ask your doctor to set out a treatment plan for you. For specific cost coverage, a cost approval is often required in advance.  

The route out of alcohol addiction can be long and difficult. It takes a lot of patience on the part of the person addicted to alcohol as well as from those around them. 

What starts as two or three glasses of wine at the weekends then becomes every two days, then every day: alcohol addiction begins gradually and can worsen just as insidiously. Difficult life circumstances as well as other factors (e.g. genetic predisposition) can turn alcohol enjoyment into alcohol addiction almost without your noticing.

Monitor yourself, try to be aware of your alcohol consumption and question it every now and then. Do not delay getting help if you notice your control slipping away. Your GP is your first point of contact.

Would you like to know whether your alcohol consumption is safe? Find out by taking this anonymous self-test from the Forel Klinik.

• weniger-trinken.ch (online self-test, in German)

• “Blaues Kreuz” (Blue Cross) (in German)
• Age and addiction (in German)
• Anonymous support for problematic situations (in German)
• Swiss Office for the Coordination of Addiction Facilities
• Findings from alcohol addiction research (in German)